Be as you wish to seem: tragedy, triumphalism, and toxicity in maternity services – Authors' reply
Authors: Hannah G Dahlen, Daniela Drandic, Neel Shah, Franka Cadee, Address Malata
Journal: The Lancet Global Health (2022)

We thank Elizabeth Sutton and colleagues for their letter emphasising that survival is the fundamental expectation of women during childbirth. Our argument is that, in designing a better system, we should aim higher. Women clearly also have goals other than emerging from childbirth unscathed. Ideally, care should be supportive, affirming, and empowering. We do not contest the Ockenden report, which clearly shows a betrayal of safety among the UK National Health Service Trust involved. We believe that the public discourse, including media reporting, would benefit from a more holistic and global perspective rather than castigating the midwifery profession, especially considering the global shortage of midwives and the potential impact this has on the lives of women and babies.1Nove A Friberg I de Bernis L et al.Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study.Lancet Glob Health. 2021; 9: e24-e32Summary Full Text Full Text PDF PubMed Scopus (65) Google Scholar It is important to point out that our Comment was an international paper examining international issues to do with midwives on the basis of high-level evidence and recommendations from leading government, disciplines, and health organisations. Our authorship team was multidisciplinary and included a consumer, an obstetrician, and three midwife experts, each working in a different global setting. Our shared perspective is that women are served best when their needs are centred and that midwives are well positioned to provide critically needed care.2Miller S Abalos E Chamillard M et al.Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.Lancet. 2016; 388: 2176-2192Summary Full Text Full Text PDF PubMed Scopus (552) Google Scholar We are deeply concerned by the ways in which midwife-led models are being constrained instead of advanced, considering the scientific evidence available. The evidence on the continuity of midwifery care model is rigorous and recognised globally,3WHOWHO recommendations: intrapartum care for a positive childbirth experience. World Health Organization, Geneva2018Google Scholar with a higher level of evidence, international support, and endorsement (ie, WHO) than most interventions routinely used and accepted in maternity care.3WHOWHO recommendations: intrapartum care for a positive childbirth experience. World Health Organization, Geneva2018Google Scholar, 4Sandall J Soltani H Gates S Shennan A Devane D Midwife-led continuity models versus othermodels of care for childbearing women during pregnancy, birth and early parenting.Cochrane Database Syst Rev. 2016; 4CD004667PubMed Google Scholar Relationship-based care is widely recommended as safe both physically and psychologically for women and their families,5Forster DA McLachlan HL Davey M et al.Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.BMC Pregnancy Childbirth. 2016; 16: 28Crossref PubMed Scopus (118) Google Scholar and should be scaled up globally, in accordance with the best available evidence. Listening to women and being guided by their needs must be the very first step. NS holds stock options at Maven Clinic. All other authors declare no competing interests. Be as you wish to seem: tragedy, triumphalism, and toxicity in maternity servicesWomen aspire to positive birth experiences and expect a live baby in their arms at the end of this process. In their Comment, Hannah Dahlen and colleagues (July, 2022)1 proclaim that women are so poorly served by current models that the aspirations of birthing women have been “set at immediate survival”. The 2022 Ockenden report highlighted that a fixation on reducing the number of caesarean sections meant that survival was more than what many women could expect. Over 200 babies and nine women served by maternity services at the Shrewsbury and Telford Hospital National Health System Trust in the UK died from systemic failures that included insufficient staff training, inadequate monitoring, poor working cultures, and an organisational drive to reduce the number of caesarean births underpinned by a truculent ideology of normal birth. Full-Text PDF Open AccessSupporting midwifery is the answer to the wicked problems in maternity careThe film Don’t Look Up, examines what it will take to get world leaders and the public to be proactive about a comet that is on a collision course with earth. We argue that the same attitude of self-interested denialism is stopping crucial action being taken when it comes to supporting midwifery models of care to address the current problems in maternity care. Full-Text PDF Open Access